Academic journal article Journal of Cultural Diversity

Beyond Self-Assessment - Assessing Organizational Cultural Responsiveness

Academic journal article Journal of Cultural Diversity

Beyond Self-Assessment - Assessing Organizational Cultural Responsiveness

Article excerpt

Abstract: While there is growing recognition of the need for health care organizations to provide culturally responsive care, appropriate strategies for assessing organizational responsiveness have not been determined. A document review assessment instrument was designed to assess best practice within eight domains, and along seven dimensions of organizational approach to diversity. Results obtained from the pilot of the instrument were congruent with data collected from key informant interviews, a focus group, observational methods and organizational feedback session; however, they were not consistent with self-assessment results at the same site. A larger pilot is required to determine generalizability of results.

Key Words: Cultural Competence, Access, Underserved Populations, Organizational Diversification, Organizational Assessment, Document Review, Self-Assessment

Addressing barriers to health care access experienced by culturally diverse groups and providing culturally competent health care are emerging as priority health care issues in many countries. The focus of interventions intended to improve responsiveness to culturally diverse groups can be directed at the level of: individual provider; program or service delivery; organization; or system (Bowen, 2004). There is increasing recognition that changes are needed at the organizational level in order to ensure access and to provide culturally competent care (Office of Minority Health, 2001a).

While there is emerging consensus on organizational best practice related to cultural competence and access to care for underserved populations (Office of Minority Health, 200Ia) there has been less progress in determining how this responsiveness can be measured. This article describes the development and pilot of a document review instrument designed to assess organizational cultural responsiveness, and compares results from the assessment instrument with both a) data obtained through other methods (key informant interviews, a focus group, participant and unobtrusive observation, and an organizational feedback session), and b) self-assessment results from the same site.

BACKGROUND/LITERATURE REVIEW

A comprehensive review of the literature on cultural competence, health care access, and health disparities was undertaken with the objectives of identifying best practice in the area of cultural competence and access, and exploring the key concepts associated with these terms (Bowen, 2004). The review included a review of current Canadian accreditation standards (CCHSA, 2001) to determine their potential as a base for further development of cultural competence standards, and assessment of existing organizational assessment instruments (Andrulis, Delbanco, Avakian, & Shaw-Taylor, 2002; Canadian Mental Health Association, 1999; Child Welfare League of America, 1993; Dreachslin, 1999; Goode, Jones, & Mason, 2002; Lewin Group, 2002; National Center for Cultural Competence, 2003; Ngo, 2000; Office of Minority Health, 2001b; Paez, 2003a, 2003b; Quander, 2003; Siegal, Davis-Chambers, Haugland, Bank, Aponte, & McCombs, 2000; Vancouver Ethnocultural Advisory Committee of the Ministry for Children and Families, 2002; Western Interstate Commission for Higher Education, 1998).

Two basic approaches to addressing issues of diversity within health care were identified: a) improving the cultural competence of providers; and b) improving access to care for underserved populations. For purposes of the project, cultural responsiveness, which incorporates aspects of both access and cultural competence, was defined simply as the ability of individuals and organizations to respond in appropriate and effective ways to the health and health care needs of culturally diverse communities.

There is a paucity of research on cultural competence and health care access, particularly on the impact and effectiveness of attempts to improve them in specific settings (Anderson, Scrimshaw, Fullilove, Fielding, & Normand, 2003; Henry J Kaiser Family Foundation, 2003). …

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